The Right to Health.

[Vraith]

And Vraith - 12% preventable and only obesity... how much does smoking add to that list? Then lets add in sedentary lifestyles... now the percentage is going up .....,

I already dealt with that uprthread, using the biggest killer as an example.
"Lifestyle" is A problem...but it is not the biggest, or even one of the top 5.
And in most ways lifestyle is merely a delaying tactic in relation to healthcare and costs.
If every person in the country started eating less and exercising more and quit smoking tomorrow, healthcare costs would hardly be affected at all...not immediately, and not in the long term.

[SoulBiter]

If every person in the country started eating less and exercising more and quit smoking tomorrow, healthcare costs would hardly be affected at all...not immediately, and not in the long term.[/color]

AHAHAHAHHAHHAHAHAH

Sorry I couldnt hear you, my BS alarm was going off too loudly.

The CDC says:

The Cost of Chronic Diseases and Health Risk Behaviors

The majority of US health care and economic costs associated with medical conditions are for the costs of chronic diseases and conditions and associated health risk behaviors.

PreventDisease.com says:

Preventable illness makes up approximately 80% of the burden of illness and 90% of all healthcare costs.

New England Journal of Medicine says:

Preventable illness makes up approximately 70 percent of the burden of illness and the associated costs.

I wont have time for a few days.. I have to fly to Ohio on business next week, but while I'm stuck at the hotel at night I will do some research on how much healthcare costs (not increased costs) but costs overall, are preventable.

[Vraith]

If every person in the country started eating less and exercising more and quit smoking tomorrow, healthcare costs would hardly be affected at all...not immediately, and not in the long term.[/color]

AHAHAHAHHAHHAHAHAH

Sorry I couldnt hear you, my BS alarm was going off too loudly.

You can think that, if you want. But what is left out of that is the disconnect between the fact of sickness and the cost of treating that sickness.
The percentage of smokers in the U.S. is half what it was...and the associated illnesses have dropped even more [because many of those illnesses were also connected to air pollution, and other factors which we've done a lot to diminish]. But the cost of treating those things has gone through the roof.
We could be healthier. It would be great to be healthier. But the cost disconnect exists.

[Obi-Wan Nihilo]

And Vraith - 12% preventable and only obesity... how much does smoking add to that list? Then lets add in sedentary lifestyles... now the percentage is going up .....,

I already dealt with that uprthread, using the biggest killer as an example.
"Lifestyle" is A problem...but it is not the biggest, or even one of the top 5.
And in most ways lifestyle is merely a delaying tactic in relation to healthcare and costs.
If every person in the country started eating less and exercising more and quit smoking tomorrow, healthcare costs would hardly be affected at all...not immediately, and not in the long term.

Bullshit. Ok, that's not very nice, perhaps I should elaborate.

You are correct that some healthcare costs are unavoidable. We spend, on average, $250K on end of life care in the last 6 months. It should be obvious that at least some of that is unnecessary. If we all accept as a given that death is truly unavoidable and can only be deferred, then a lot of the care that is being rendered doesn't truly improve anyone's outcome or meaningfully improve the quality of their life. In fact in all too many cases the quality of life goes straight into the toilet. End of life counseling and death with dignity is the way we are headed, because the fiscal math is the fiscal math. We are going to have to make peace with death. And people that put themselves on death's door due to their own choices are going to be manifested into the same necessity.

[Zarathustra]

Putting people at a lower priority than others is punitive. They had best deserve this punitive action. What did they do to deserve punitive action? This is the question I am asking.

These are decisions that we don't have to make as long as we don't have universal health care. Once you do have universal health care, the government will indeed prioritize based on cost effectiveness. They might say you're too old to have a knee replacement (using an example Obama himself gave), saving those resources for someone younger. I gave the example of the drug Provent: men who get prostrate cancer and want to live a few months extra are at a lower priority to receive this drug in the UK, because it's expensive and the government doesn't think it's a wise decision to spend $90,000 on these people for that particular health care need. So what did they do to deserve this "punitive" action?

Or perhaps there's a problem with saying prioritizing = punishment. Every single universal health care makes cost effectiveness decisions--i.e. prioritizing care. So if you're against prioritizing health care, perhaps you should favor the system we have, or even better, an improved market system that lowers cost for everyone, so that no one has to make these kinds of prioritization decisions.

[Vraith]

Bullshit. Ok, that's not very nice, perhaps I should elaborate.

You are correct that some healthcare costs are unavoidable. We spend, on average, $250K on end of life care in the last 6 months.

You are correct on the second. Savings are available there. And in related things that lead up to that point.

Nevertheless, I'll repeat what I said in response to SB, perhaps in slightly different way:

If one thinks that the fact of fat lazy smokers is the biggest, or even one of the biggest causes of increased healthcare costs, one is looking too small, focusing too narrowly, or looking in the wrong places. [or some or all of those three].

Really good diet and lifestyle choices will beyond doubt result in higher quality of life.

But they simply won't result in significantly lower cost all by themselves.

It may seem odd to say that many millions, even many tens of millions, of people will have better health and better lives if they make better choices, but that it won't make a huge difference in the cost problem. Nevertheless, it is true.

[SoulBiter]

Really good diet and lifestyle choices will beyond doubt result in higher quality of life.

But they simply won't result in significantly lower cost all by themselves.

It may seem odd to say that many millions, even many tens of millions, of people will have better health and better lives if they make better choices, but that it won't make a huge difference in the cost problem. Nevertheless, it is true[/color].

You keep saying it, but that doesn't make it true. The CDC and the New England Journal of Medicine both say you are wrong.... explain why you right and they are wrong? And it cant be just because you think so. Well I guess it can, but that and a nickle gets you a small stick of gum.

[Obi-Wan Nihilo]

There is no way to profitably market healthcare to the dying. There just isn't, and that is why a public system exists now and always will in some form or other. I'd like to minimize it and make it truly cost effective but it's always going to be there. There ARE certain economies that can be realized by keeping certain sectors of the healthcare market private (care like vision and plastic surgery are often cited as successful examples of healthcare services with improving efficiencies and lowered costs, due to their subjection to market forces). But the really big expenses, the ones that cannot be prevented, are simply not affordable without putting everyone (or nearly everyone) into the same basket. The more Spartan and disciplined that basket the better IMO, though Democrats see it as an opportunity to try to promise almost everything to everyone that might vote for them without worrying about the future costs. I think that is the wrong way to go, but the proper rebuttal isn't offering pie in the sky.

[Vraith]

Really good diet and lifestyle choices will beyond doubt result in higher quality of life.

But they simply won't result in significantly lower cost all by themselves.

It may seem odd to say that many millions, even many tens of millions, of people will have better health and better lives if they make better choices, but that it won't make a huge difference in the cost problem. Nevertheless, it is true[/color].

You keep saying it, but that doesn't make it true. The CDC and the New England Journal of Medicine both say you are wrong.... explain why you right and they are wrong? And it cant be just because you think so. Well I guess it can, but that and a nickle gets you a small stick of gum.

Already given a couple examples you could look into and discover the differential.
But here's another you can look into:
My parents are healthy, mostly, have a cheap prescriptions each.
They have to pay four times the cost of the drugs for visits to the doctors office...at which NO EXAMS TESTS OR PROCEDURES are conducted...just to renew prescriptions.
[[if anything is required, then they pay EVEN MORE.]]
Here's another: look at "rent" for care places. Compare what they charge to what they do, and the necessity to the effectiveness.

[Obi-Wan Nihilo]

thinkprogress.org/health/2013/07/10/2281401/oklahoma-surgical-center-price-transparency/

In Oklahoma City, one surgical center is successfully reducing the price tag for their procedures by thousands of dollars — and encouraging nearby hospitals to follow suit.





What’s the secret?

The two doctors who started the Surgery Center of Oklahoma, Dr. Keith Smith and Dr. Steven Lantier, are committed to charging fair prices, and they founded their hospital with the goal of price transparency. “What we’ve discovered is health care really doesn’t cost that much,” Dr. Smith told KFOR-TV. “What people are being charged for is another matter altogether.”

They have been posting all of their prices online for the past several years, and they charge significantly less than other hospitals in the area.

“When we first started we thought we were about half the price of the hospitals,” Dr. Lantier said. “Then we found out we’re less than half price. Then we find out we’re a sixth to an eighth of what their prices are. I can’t believe the average person can afford health care at these prices.”

After comparing the Surgery Center’s prices with the bills for the same surgical procedures at other Oklahoma City hospitals, KFOR-TV confirmed just how wide that gulf is. For example, a $3,500 breast biopsy at Surgery Center of Oklahoma will cost $16,244 at nearby Mercy Hospital. A hysterectomy jumps from $8,000 at Surgery Center to $37,174 at Integris Baptist Hospital. And the OU Medical Center consistently charges about $15,000 more than what the Surgery Center does for common procedures like open fracture repairs and gall bladder removal.

[Vraith]

thinkprogress.org/health/2013/07/10/2281401/oklahoma-surgical-center-price-transparency/

weren't you just telling me I was full of shit that costs weren't high cuz people were sick, but because of other stuff?
and now you're proving my point.
Welcome the side that will get insulted or dismissed or both.

[Zarathustra]

thinkprogress.org/health/2013/07/10/2281401/oklahoma-surgical-center-price-transparency/

weren't you just telling me I was full of shit that costs weren't high cuz people were sick, but because of other stuff?
and now you're proving my point.
Welcome the side that will get insulted or dismissed or both.

Many of us have been pointing out reasons why the American health care system is more expensive. Utilization is one of the biggest driving factors. And if that utilization is preventable (as SB's data largely showed, and you dismissed or ignored), that's money we can save. But without a doubt it costs more than it needs to cost, for other factors as well. That's why people like me have been calling for consumer-driven health care, that more accurately connects prices to supply/demand. If there weren't exorbitant costs built in, then my solution wouldn't work, because there would be no room for prices to come down.

[Zarathustra]

There is no way to profitably market healthcare to the dying. There just isn't, and that is why a public system exists now and always will in some form or other. I'd like to minimize it and make it truly cost effective but it's always going to be there. There ARE certain economies that can be realized by keeping certain sectors of the healthcare market private (care like vision and plastic surgery are often cited as successful examples of healthcare services with improving efficiencies and lowered costs, due to their subjection to market forces). But the really big expenses, the ones that cannot be prevented, are simply not affordable without putting everyone (or nearly everyone) into the same basket. The more Spartan and disciplined that basket the better IMO, though Democrats see it as an opportunity to try to promise almost everything to everyone that might vote for them without worrying about the future costs. I think that is the wrong way to go, but the proper rebuttal isn't offering pie in the sky.

You don't market health care to the dying. By then, it's too late. We should be aggressively educating and marketing health savings accounts to young, healthy people, so they'll build up enough money in their accounts to take care of their own end-of-life care. That money can grow just like a retirement fund. That's not pie in the sky.

[Hashi Lebwohl]

thinkprogress.org/health/2013/07/10/2281401/oklahoma-surgical-center-price-transparency/

The other secret is that the Surgery Center doesn't have people walking into their ER with a runny nose because they are in chronic poverty and they don't know any better. The thought process is something like "holy cow! I am not 100% well but I don't have any money so I'll go to the ER where they have to see me." rather than going to some place like a MinuteClinic in the neighborhood CVS (or other big-box pharmacy). Hospitals typically have to eat those ER costs and this gets especially bad when the hospital is being run as a for-profit organization.

Hospitals should start assigning a nurse to wait at the intake counter who can perform a quick, immediate 5-minute assessment of someone coming in. If the new arrival doesn't have something which really qualifies as "an emergency" (no broken bones, no open wounds, no anaphylaxis, etc) then they should be directed to visit a clinic like the one mentioned above *or* they should have to sign a waiver stating that they are going to receive a bill. This would stop ER visits for non-emergencies and drive costs back down. Let's just hope the quick-intake nurse doesn't make a mistake...but that is probably too risky.

[Vraith]

And if that utilization is preventable (as SB's data largely showed, and you dismissed or ignored),

didn't ignore or dismiss it. Made the point that most aren't actually preventable. They're only reducible and/or postponable. And, except for some very specific instances, many---and usually most---of the people with the conditions don't HAVE the risk factors everyone keeps complaining about...fat, lazy, smokers.
In most cases...especially the ones that actually kill the most people...the single common and greatest [by far] risk factor is simply getting older.

[wayfriend]

They willfully caused their own illnesses.

Preposterous.

They willfully caused their own illness.

Preposterous.

The choice to willfully cause one's own illness.

Still preposterous.

No one's intention is to be unhealthy.
Just as no one's intentions is to consume health resources at someone else's expense.
There is no 'willfully ' here.
It's preposterous.

I really wish you would state the basis for your declaration,
instead of the one you are making up which you hope sounds better than the real one.
Because the one which you hope sounds better doesn't hold up on inspection.

- - - - -

It's too bad no one can point to the crime for which they think some people should be punished.

Here's what it [probably] really is: Sorry Joe, the system is more economical for me if you get screwed over. It's nothing personal. It's just that I will save some pennies this way.

In other words, the justification is greed.

[Zarathustra]

You can willfully cause something that you didn't intend. I can willfully decide to drink too much to drive, willfully decide to get into a car, and hope for the best. Just because my intentions aren't to kill a family doesn't mean that I'm not culpable. I'm culpable because I willfully made the choices that caused it, knowing damn well that my behavior is risky (just as junk food eaters and smokers know their behavior is risky).

Being unhealthy isn't a crime. But insisting that people who create their own problems have no RIGHT to take my money to fix them isn't punishment ... no more than it's punishment to say you don't have the right to take my money to fix your car that you wrecked.

I think people who create their own health problems should still be helped in emergency situations (though there's nothing wrong with billing them later, right?), and I'm in favor of a safety net for those who truly can't afford medical care for non-emergencies, too. But I think the people who truly can't afford health insurance are a tiny group. Like I've said many times, if you can't afford $40/month premium (as my family pays), then what the hell could you afford?? It's your health. I think that's a bargain. In fact, it's more than most smokers pay for cigarettes, or more than most unhealthy eaters spend on junk food. If you can't pay this, your problems are much greater than being a smoker or being fat.

[Hashi Lebwohl]

No one's intention is to be unhealthy.
Just as no one's intentions is to consume health resources at someone else's expense.
There is no 'willfully ' here.
It's preposterous.

If someone develops type II diabetes, which doctor used to call "adult onset" because it wasn't a congenital disease, then whose fault is it, given that the disease is apparently avoidable? Did society make them come down with it? Did someone hold a gun to their head and force them to eat foods laden with processed sugars and preservatives and too much fat? Is it their parents' fault for not instilling good food choices into them when they were children? Is it their employer's fault for giving them a desk job? Is it the food manufacturers' fault for putting unhealthy choices on the shelves of grocery stores? Is the grocery stores' fault for giving those choices prime shelf space at eye level and for parking the produce section at the back of the store?

If no one intends to become unhealthy yet it happens anyway then who is to blame?

Or...perhaps we shouldn't go around blaming anyone? Still...if someone knows what sorts of foods could lead to health problems in the future yet they eat those foods anyway, doesn't that qualify as "intent"?

Agreed on one other point, though--for all intents and purposes health services do not constitute a zero-sum game. Your visit to the doctor doesn't prevent me from going to the doctor.

[Zarathustra]

Agreed on one other point, though--for all intents and purposes health services do not constitute a zero-sum game. Your visit to the doctor doesn't prevent me from going to the doctor.

Then why do you ever have to wait? Someone else's utilization does indeed affect yours.

However, there are other senses in which it's not a zero-sum game, after all the doctor gets paid and you get health care. Both are better off.

[wayfriend]

No one's intention is to be unhealthy.
Just as no one's intentions is to consume health resources at someone else's expense.
There is no 'willfully ' here.
It's preposterous.

If someone develops type II diabetes, which doctor used to call "adult onset" because it wasn't a congenital disease, then whose fault is it, given that the disease is apparently avoidable?

Why does it matter? Why do we need blame?

Is it possible to assign blame to every medical problem?

I play soccer, I twist my ankle. Does the fact that it's my fault I twisted my ankle mean I don't get medical care?

How does one even live a life where they avoid all fault for all medical problems?

No. Seeking out whom to blame here seems to me like a way to justify something that you already want to do anyway. This is why it, too, makes no sense on close inspection. It's an attempt to find a plausible reason, but it's not the real reason.